The rubber has finally hit the road
A BMJ Head to Head 'Are condoms the answer to rising rates of non-HIV sexually transmitted infection?' revealed astonishing concordance between camps. For 'Yes', Steiner and Cates were positive about abstinence even though it is 'difficult to achieve', warned about 'risk compensation' (feeling safer so taking more risks), and said the 'ABC' strategy was a 'reinforcing epidemiologic truism'. Genuis, for 'No', described the limits to protection and commented 'the relentless rise of sexually transmitted infection in the face of unprecedented education about and promotion of condoms is testament to the lack of success of this approach'. (BMJ 2008; 336:184-5)
Screening requires wisdom
Gordon Brown's announcement that GPs would screen much more for diabetes, aneurysms, and kidney disease met a cool reception, not just because of the lack of prior consultation with the profession and the perhaps ill-advised diversion of funds, but because it failed to appreciate the principles of screening. Glasgow GP Des Spence: 'The inverse care effect will, as ever, see the predictable, miserable lines of low risk, worried well clogging up NHS services. The high risk, unworried sick will continue happily to ignore our screening initiatives.' (BMJ 2008; 336:160)
Cannabis and lung damage
One area where government could usefully intervene for health would be to reclassify cannabis as a Class B drug, having downgraded it to Class C in 2004. Two recent studies highlighted by the BBC suggest that compared to tobacco smokers, heavy cannabis users are at greater risk of chronic lung disease and cancer. Bullous emphysema occurs 20 years earlier in cannabis smokers, and smoking one joint a day gave a higher risk of lung cancer than smoking 20 cigarettes a day over the same period. (http://news.bbc.co.uk/1/hi/health/7217601.stm)
Sheffield SpR Becky Hirst says 'palliative medicine is fun' and mentions 'the rather dark hospice humour'. She describes a hospice volunteer who 'sheepishly recalled collecting dirty crockery. Entering a room where the family was gathered, the end being near, he indicated to the used cups and said: “Are these dead?”' Later she adds: 'The West would do well to learn from Buddhism, which embraces death and dying as integral parts of life's journey that have to be done as well as possible.' (BMA News 2008; 19 January: 7)
A bridge to peace
On a clinical attachment in Israel, SpR in respiratory paediatrics Patrick Stafler saw medicine as 'a bridge to peace' and believes doctors can convey harmony. His article begins with a quote from Isaiah 2:4: 'Nation will not lift sword against nation and they will no longer study warfare'. Perhaps somewhat out of context, but Eutychus is always glad to see scriptural quotes in the journals. (BMJ Careers 2007; 8 December: GP219)
A real choice?
Leeds GP James Gerrard considers the concept of choice in relation to abortion and the effect on decision making. Quoting a previous article that 'framing a decision as a choice can enhance the perceived value of a particular option' he suggests 'perhaps the default state for a society in dealing with crisis pregnancy shifts towards abortion and more women may opt for it'. And perhaps that's why BPAS in their regular advert in the same journal headline 'choice, value and expertise' and conclude 'pregnant women know that they have a choice. A real choice.' (BJGP 2007; December: 996, 978)
The US Food and Drug Administration has authorised the sale of meat and milk from cloned cattle, pigs and goats and from the offspring of such clones. The FDA does not expect clones themselves to enter the food supply as they are expensive and rare, and most of the 600 or so US cloned animals will be used for breeding. Their offspring, bred normally, will be used for food. No special labelling of meat or milk products is required, and the US public seems unconcerned. If the same happened here, we might expect 'Frankenfood' headlines. (BMJ 2008; 336:176)
Doctor as 'surrogate priest'
A substantial article about roles suggests that the 21st century GP will have to be physician and priest. To illuminate this claim the authors draw on the paradoxes of censuses. While 'the most recent national government census in 2001 still highlighted Christianity as the religion of 72% of the population', at the same time 'there has been a well-documented decline in church going in the UK. The reasons for this are numerous and are for theologians and clerics to address, but… the 2005 English Church Census… revealed that 94% of the population do not go to church'. (BJGP 2007; October: 840-2)
Ophthalmologist member Will Sellar had a helpful piece in BMJ Careers about apologising, which used Scripture to confirm the important principle of 'not letting the sun set while still angry' (Ephesians 4:26) and suggesting the reconciling spirit of Matthew 5:23-6 to prevent bitterness. Unfortunately, while the references were listed at the end, an editorial oversight meant they were not indicated within the text. (BMJ Careers 2007; 15 September: GP103-4)
A review of a Dutch TV documentary investigating cosmetic surgery stated 'by the time every girl reaches 17 she is likely to have seen an estimated 250,000 beauty related images. Every year in the Netherlands 1,000 young women seek cosmetic vaginal surgery – but why?' Peter tells us in 1 Peter 3:3-4 that 'your beauty should not come from outward adornment… it should be that of your inner self, the unfading beauty of a gentle and quiet spirit'. (BMJ 2007; 335:541)